Reasonable & Customary Limits

What is Reasonable and Customary (R&C)?

Reasonable and customary charges are the fees charged by out-of-network providers for comparable services in the same geographic location, as determined by the plan administrator. The reasonable and customary amount is not necessarily the same as the amount your doctor charges.

For example, R&C for a covered service may be $100, but your out-of-network doctor might charge $125 for that service. Assuming you have met the deductible, the plan will pay benefits based on $100. You are responsible for the balance. Any additional amounts you pay above R&C are not counted towards the annual deductible or out-of-pocket maximum.